The Dirty Secrets of Healthcare – How to Tackle This Industry and WIN!

 

How would you spend a million dollars? 

 

Would it be a garage full of luxury cars? A destination vacation, perhaps? Maybe the down payment on a mansion? 

 

My guess is a hospital bill didn’t make your top ten or even your top 1,000,000 list.  

 

A bill topping a million dollars is the largest investigative journalist Marshall Allen has ever seen.  

 

The bill came from California-based Dignity Health, to a new mom, who happened to be a nurse in their system. Unfortunately, the baby was born premature and other complications landed the mother in Intensive Care. 

 

That’s partly why the bill was so large—the other reason, a benefits mix-up. 

 

The mom had 30 days after the birth to get her baby on her health insurance. The mom called the company administrating the plan for Dignity Health.  

 

“She thought that it was done. It turns out that the employer required her to go into their HR employer portal and add the child within 30 days. If she didn’t do it through the HR portal, then the baby would not be covered. She didn’t find this out until after 30 days,” Marshall recalled.  

 

According to Marshall, the new mom pleaded with the employer and the health insurance to correct this technicality. But, unfortunately, neither budged until Marshall got involved. 

 

“This again is Dignity Health, a faith-based healthcare system that says that they want to share the healing Ministry of Jesus Christ. They would not even take care of their own mom, who was a nurse in their facility,” Marshall said. “They made the correction. They fixed it. By me making those calls saved her literally one million dollars in medical bills. She jokes that she calls her baby her million-dollar baby. Thankfully, it didn’t end up being a million dollars that sent her into bankruptcy.” 

 

The story of the million-dollar baby isn’t the only health insurance anecdote Marshall has to share. He wrote a whole book full of them titled, Never Pay the First Bill and Other Ways to Fight the Health Care System and Win.   

 

Marshall and I connected after sharing the stage at a healthcare event earlier this year. I knew this topic would be helpful and enlightening for our C-Suite Network community, so we invited him to be our guest speaker in a recent Digital Discussion.  

 

Needless to say, Marshall isn’t a fan of our healthcare system as it currently operates.

 “The health care system has developed a series of deceptive schemes to take more of our money than they should,” Marshall emphasized. “American medicine is profiteering based on our sickness, and the dirty secret here is that the high cost of health care in the United States is not justified. It does not have to be this high. What we have is gamesmanship by people who are running the healthcare industry, and they have created deceptive schemes to take our money.” 

 

While Marshall blames big healthcare systems for these high bills, don’t expect our politicians to hold the industry accountable. He says if Washington were serious about changing the system, it would have happened by now.  

 

He says disruption is the consumer’s best hope of fighting back and it’s already happening. But, if you can’t wait for innovation, he says one of the best ways patients can tackle the healthcare system is through education. 

“I have talked to so many patients who are so smart, I know that they have the capability to learn this and to apply this knowledge,” Marshall said. “I think (Pay the First Bill) is a game-changer to up the health literacy for patients.” 

 

Marshall says this starts with learning how to read a medical bill. He says you should always ask for the itemized bill. He says most experts who review medical bills for a living say many have some sort of error.  

 

“The next thing you want to do is make sure that itemized bill has the billing codes. These billing codes are the lexicon that the hospital uses to translate the medical record into the claims they submit to insurance companies. When you have those bills, you have like the Rosetta Stone to understand how the prices work,” Marshall said. 

 

There’s another resource. Marshall says a recent change to federal law requires health systems to post their prices for services. Unfortunately, some hospitals aren’t making it easy, making these price sheets hard to find.  

 

“I think a day is coming soon where you’re going to be able to look up the price of a gallbladder surgery, schedule it at a place where you know you’ll get a better value,” Marshall said. 

 

The hunt for a better value leads Marshall to one of what he calls “the dirty secrets” of healthcare. The industry is a lot more standardized than you think. While you may be impressed with the surgical clinic with a spa-like atmosphere for your upcoming procedure, there’s not much difference in care. 

 

“If you get a knee replacement, you could go to the marquee medical center in your town and go to someplace that’s branded and ranked,” Marshall said. “You might pay a $60,000 or something for a knee replacement there. You could go to a community hospital; you would get the same quality knee replacement. Same components. Same trained doctor. Same trained operating room staff. Same positive outcome and pay $20,000. So, you don’t get more for your money by spending more on health care.” 

 

There’s so much more to our conversation on navigating the healthcare system than I could write in this article – and with this much content, we turned it into an episode of All Business with Jeffrey Hayzlett. Marshall enlightened me on the realities of “defensive medicine,” why suing hospitals in small claims court is an effective strategy to lower your next bill, and how he’s made it his mission to improve healthcare literacy through the Allen Health Academy,  designed for both consumers and companies looking to get an edge to rising healthcare costs.